Provider Demographics
NPI:1699158964
Name:GP MEDICAL MANAGEMENT GROUP INC
Entity type:Organization
Organization Name:GP MEDICAL MANAGEMENT GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YUKO
Authorized Official - Middle Name:
Authorized Official - Last Name:JONAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-666-8295
Mailing Address - Street 1:2634 S CARRIER PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-5005
Mailing Address - Country:US
Mailing Address - Phone:469-434-4318
Mailing Address - Fax:
Practice Address - Street 1:2634 S CARRIER PKWY STE 105
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-5005
Practice Address - Country:US
Practice Address - Phone:972-666-8295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GP MEDICAL MANAGEMENT GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-06
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty